Agenda item

To receive and agree a report with recommendations on the governance arrangements for the Better Care Fund.   

The Board received a joint report on the Better Care Fund Governance Arrangements from Ray James, Director of Health, Housing and Adult Social Care and Liz Wise, Enfield CCG Chief Officer. 

1.               Presentation of the Report

Bindi Nagra, Assistant Director Strategy and Resources introduced the report.  Richard Young, Interim Better Care Fund Programme Manager, presented it to the board using a powerpoint presentation.  Copies of the slides are attached to the agenda. 

The following points were highlighted: 

·       The Better Care Fund submission had been accepted with support.  One of the outstanding requirements was to agree the fund’s governance arrangements: the committee is asked to agree these tonight.   The other concerned the management of the money, which it was proposed would be handled through the section 75 agreement.  This will be looked at, at a future meeting. 

·       Two options have been put forward to replace the current arrangements.  The original structure of working group and sub board, which had been created to develop the proposals and submit the application, was no longer fit for purpose. 

·       The first option involved creating a new Integration Board which would include management of the Better Care Fund as well as wider integration matters.  It would have some measure of delegation. 

·       The second option would merge the Better Care Fund, into the existing Joint Commissioning Sub Board.  This would be purely advisory.  All decisions would be fed back to the full board. 

·       The preference of the current working group was for Option 1 focussing on integration.  Joint Commissioning was felt to be a wider issue which required its own sub board. 

·       Further details on the terms of reference would be discussed at a future meeting. 

2.               Questions/Comments

2.1     The view was expressed that the voluntary sector had better representation in Option 2.  Ray James responded that in principle there wouldn’t be any difference in voluntary sector representation between the two options.  Both were intended to be appropriately inclusive and he felt that this should not be a determinant in a choice between the options. 

2.2     It was envisaged that in Option 1 it would be possible to consider and focus on the whole shape of integration across health and social care.  Also incorporating the existing older people’s integration board.  In Option 2 the issue of integration could get lost within the whole range of commissioning activities which fall under the scope of the Joint Commissioning Board.  Whichever option was chosen there would be overlap. 

2.3     The Better Care Fund was an enabler which would help to bring about better service integration, bringing together system leaders and providers. 

2.4     The suggestion was made that someone with specialist knowledge of safeguarding issues should be included. 

2.5     Many more interested parties would be specifically represented in the sub structures of the main sub board. 

2.6     There was no political representation in either option but this was up to the board to address, if it was felt that it was needed. 

2.7     In Option 1 there was differentiation between voting and non-voting members as it was envisaged that this group would have delegated decision making powers and that some members could have conflicts of interest.  In the second option all decisions would be referred back to the full board. 

2.8     Voting would be unusual, as it was hoped that most decisions could be taken on a consensual basis.  Voting had not taken place at the Health and Wellbeing Board so far.  In the event of a disagreement, then matters could be referred back to the full board. 

2.9     It was suggested that the proposed membership of the Stakeholder reference group should be wider.  Under either option a series of sub groups/work streams would be set up to look at specific areas: key people with the appropriate expertise would be invited to take part and provide advice. 

2.10    These groups will not replace formal consultation and engagement activities. 

2.11    Andrea Clemons asked why there was no representative from the Regeneration and Environment department.  Bindi Nagra agreed discuss this with Ian Davis, Director of Regeneration and Environment. 

2.12    There was nothing to bar the voluntary sector representative having a vote on the sub board.  He or she would need to declare their interests in the same way as any other representative. 

2.14    It was suggested that any voting members should have the power to refer an issue back to the full board, if they felt it was necessary. 

2.15    Any decision taken this evening would be subject to review.  It was suggested a review could take place after 3 months. 

AGREED that

1.               The Board would adopt Option 1 and the associated remit and membership, with the addition of the voluntary sector representative who would also have a voting place on the sub board, for the governance of the Better Care Fund as set out in the report. 

2.               Any individual voting member will be able to refer matters back to the board for decision, if they think it necessary. 

3.               The London Borough of Enfield and the Enfield Clinical Commissioning Group will explore wider opportunities for pooling their respective budgets under the integration agenda (as set out in section 3.4 of the report).

4.               The terms of reference (when agreed) and governance structure, will be reviewed after three months of operation.